Comment
Fistulas between the aorta and tracheobronchial tree are rare and uniformly fatal if not surgically treated (1,2). More than 95% of patients present with hemoptysis and greater than 50% with massive hemoptysis (>400 mL); dyspnea and cough were also common (1). These fistulas most commonly involve the left bronchial tree (3). Macintosh et al noted 92% of cases involved the descending thoracic aorta to left bronchial tree and 87% involved a thoracic aortic aneurysm after graft repair (2).
Aorto-tracheal fistulas are very rarely described, with most cases likely being lethal prior to any intervention (3,4). Allende et al described a fistula between the trachea and aortic arch found on autopsy in a patient with tracheal squamous cell carcinoma two years after completing radiation therapy. He presented in cardiac arrest after massive hemoptysis (3). Two cases of aorto-tracheal fistula following repair of pulmonary artery sling and tracheoplasty in children are reported, both successfully repaired via cardiopulmonary bypass and repair with pericardial patch of the aortic arch. One tracheal defect was also repaired with pericardial patch and the other with tracheal reconstruction with cadaveric tracheal homograft (4,5).
To our knowledge, this is the first report of an aorto-tracheal fistula successfully treated with a transverse aortic arch replacement and complex tracheal repair using autologous pericardium with an omental buttress.